Psychological Inflexibility, Anxiety and DepressionThe Moderating Role of Cognitive Fusion, Experiential Avoidance and Activation

  1. Concepción Fernández-Rodríguez 1
  2. Rocío Coto-Lesmes 1
  3. Víctor Martínez-Loredo 2
  4. Marcelino Cuesta-Izquierdo 1
  1. 1 Universidad de Oviedo
    info

    Universidad de Oviedo

    Oviedo, España

    ROR https://ror.org/006gksa02

  2. 2 Universidad de Zaragoza
    info

    Universidad de Zaragoza

    Zaragoza, España

    ROR https://ror.org/012a91z28

Zeitschrift:
Psicothema

ISSN: 0214-9915,  1886-144X

Datum der Publikation: 2022

Ausgabe: 34

Nummer: 2

Seiten: 240-248

Art: Artikel

DIALNET GOOGLE SCHOLAR lock_openOpen Access editor

Andere Publikationen in: Psicothema

Zusammenfassung

Background: Evidence about how cognitive fusion (CF) and experiential avoidance (EA) interact with emotional distress underlines the importance of analyzing the interrelationships between the different processes of psychological inflexibility in order to improve ways of addressing emotional problems. This study analyzes the moderating effect of CF, EA and activation (A) in relation to four criteria of anxiety and depression. Method: A cross-sectional study of a clinical sample of adults was carried out by means of a questionnaire administered before (N = 172) and 6 months after (N = 114) participation in a clinical study. Results: Regression analyses gave results which were consistent in the two evaluations. The EAxCF interaction modulated anxiety symptomatology, whereas A was not a significant predictor. Nevertheless, a reduction in A was the principal modulating condition in the symptomatology of depression; and although CF and EA did act as independent predictors, the EAxCF interaction was not significant. Conclusions: The presence and intensity of manifestations of emotional distress are explained and modulated by the progressive concurrence of CF, EA and reduction in A. The use of therapeutic approaches which increase activation could be a beneficial strategy with regard to decreasing cognitive fusion and experiential avoidance.

Bibliographische Referenzen

  • Armento, M. E., & Hopko, D. R. (2007). The Environmental Reward Observation Scale (EROS): Development, validity, and reliability.Behavior Therapy, 38(2), 107-119. https://doi.org/10.1016/j.beth.2006.05.003
  • Bacigalupe, A., & Martín, U. (2020). Gender inequalities in depression/anxiety and the consumption of psychotropic drugs: Are we medicalizing women’s mental health? Scandinavian Journal of Public Health, 49(3), 317-324. https://doi.org/10.1177/1403494820944736
  • Bardeen, J. R., & Fergus, T. A. (2016). The interactive effect of cognitive fusion and experiential avoidance on anxiety, depression, stress and posttraumatic stress symptoms. Journal of Contextual Behavioral Science, 5(1), 1-6. https://doi.org/10.1016/j.jcbs.2016.02.002
  • Barraca, J., & Pérez-Álvarez, M. (2010). Adaptación española del Environmental Reward Observation Scale (EROS) [Spanish adaptation of the Environmental Reward Observation Scale (EROS)]. Ansiedad y Estrés, 16(1), 95-107.
  • Beck, A. T., & Steer, R. A. (1993). Beck depression inventory manual. The Psychological Corporation.
  • Berghoff, C. R., Ritzert, T. R., & Forsyth, J. P. (2018). Value-guided action: Within-day and lagged relations of experiential avoidance, mindful awareness, and cognitive fusion in a non-clinical sample. Journal of Contextual Behavioral Science, 10, 19-23. https://doi.org/10.1016/j.jcbs.2018.07.005
  • Brinkmann, S. (2019). Persons and their minds: Towards an integrative theory of the mediated mind. Routledge.
  • Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676-688. https://doi.org/10.1016/j.beth.2011.03.007
  • Burkhouse, K.L., Gorka, S.M., Afshar, K., & Phan K.L. (2017). Neural reactivity to reward and internalizing symptom dimensions. Journal of Affective Disorders, 217, 73-79. https://doi:10.1016/j.jad.2017.03.061
  • Cookson, C., Luzon, O., Newland, J., & Kingston, J. (2020). Examining the role of cognitive fusion and experiential avoidance in predicting anxiety and depression. Psychology and Psychotherapy: Theory, Research and Practice, 93(3), 456-473. https://doi.org/10.1111/papt.12233
  • Coto-Lesmes, R., Fernández-Rodríguez, C., & González-Fernández, S. (2020 a ). Activación conductual en formato grupal para ansiedad y depresión. Una revisión sistemática [Behavioral activation in group format for anxiety and depression. A systematic review]. Terapia Psicológica, 38(1), 63-84. https://doi.org/10.4067/S0718-48082020000100063
  • Coto-Lesmes, R., Fernández-Rodríguez, C., & González-Fernández, S. (2020b ). Acceptance and commitment therapy in group format for anxiety and depression. A systematic review. Journal of Affective Disorders, 263, 107-120. https://doi.org/10.1016/j.jad.2019.11.154
  • Cuijpers, P., Karyotaki, E., de Wit, L., & Ebert, D. D. (2020). The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review. Psychotherapy Research, 30(3), 279-293. https://doi.org/10.1080/10503307.2019.1649732
  • Cuijpers, P., Quero, S., Dowrick, C., & Arroll, B. (2019). Psychological treatment of depression in primary care: Recent developments. Current Psychiatry Reports, 21(12), 1-10. https://doi.org/10.1007/s11920-019-1117-x
  • Fernández-Rodríguez, C., Coto-Lesmes, R., Martínez-Loredo, V., González-Fernández, S., & Cuesta, M. (2022). Is Activation the active ingredient of transdiagnostic therapies? A randomized clinical trial of Behavioral Activation, Acceptance and Commitment Therapy, and transdiagnostic Cognitive-Behavioral Therapy for emotional Disorders. Behavior Modification, 1-42. http://doi.org/10.1177/01454455221083309
  • Fernández-Rodríguez, C. (2021). TRANSACTIVA. A randomized clinical trial of behavioral activation, acceptance and commitment therapy, and transdiagnostic cognitive-behavioral therapy for emotional disorders (Mendeley Data; Version 1) [Data set]. Mendeley. https://doi.org/10.17632/krj3w2hfsj.1
  • Fernández-Rodríguez, C., González-Fernández, S., Coto-Lesmes, R., & Pedrosa, I. (2020). Behavioral activation and acceptance and commitment therapy in the treatment of anxiety and depression in cancer survivors: A randomized clinical trial. Behavior Modification, 1-38. https://doi.org/0145445520916441
  • Fernández-Rodríguez, C., Paz-Caballero, D., González-Fernández, S., & Pérez-Álvarez, M. (2018). Activation vs. experiential avoidance as a transdiagnostic condition of emotional distress: An empirical study. Frontiers in Psychology, 9, Article 1618. https://doi.org/10.3389/fpsyg.2018.01618
  • Fonseca-Pedrero, E., Pérez-Álvarez, M., Al-Halabí, S., Inchausti, F., Muñiz, J., López-Navarro, E., Pérez, A., Molina, L. B., Debbané, M., Bobes-Bascarán, M.T., Gimeno-Peón, A., Prado-Abril, J., Fernández-Álvarez, J., Rodríguez-Testal, J.F., González, P.D., Díez-Gómez, A., García, J.M., García-Cerdán, L., Osma, J. ... Marrero, R.J. (2021). Tratamientos psicológicos empíricamente apoyados para adultos: una revisión selectiva. Psicothema, 33(2), 188-197. https://doi.org/10.7334/psicothema2020.426
  • Forbes, C. N. (2020). New directions in behavioral activation: Using findings from basic science and translational neuroscience to inform the exploration of potential mechanisms of change. Clinical Psychology Review, 79, Article 101860. https://doi.org/10.1016/j.cpr.2020.101860
  • García-Campayo, J., Zamorano, E., Ruiz, M. A., Pardo, A., Pérez-Páramo, M., López-Gómez, V., Freire, O., & Rejas, J. (2010). Cultural adaptation into Spanish of the Generalized Anxiety Disorder-7 (GAD-7) scale as a screening tool. Health and Quality of Life Outcomes, 8(1), 1-11. https://doi.org/10.1186/1477-7525-8-8
  • Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., Kerr, S., Tansey, L., Noel, P., Ferenbach, C., Masley, S., Roach, L., Lloyd, J., May, L., Clarke, S., & Remington, B. (2014). The development and initial validation of the Cognitive Fusion Questionnaire. Behavior Therapy, 45(1), 83-101. https://doi.org/10.1016/j.beth.2013.09.001
  • González-Fernández, S., & Fernández-Rodríguez, C. (2019). Acceptance and commitment therapy in cancer: Review of applications and findings. Behavioral Medicine, 45(3), 255-269. https://doi.org/10.1080/08964289.2018.1452713
  • González-Fernández, S., Fernández-Rodríguez, C., Paz-Caballero, M. D., & Pérez-Álvarez, M. (2018). Treating anxiety and depression of cancer survivors: Behavioral activation versus acceptance and commitment therapy. Psicothema, 30(1), 14-20. https://doi.org/10.7334/psicothema2017.396
  • González-Fernández, S., Fernández-Rodríguez, C., Mota-Alonso, M. J., García-Teijido, P., Pedrosa, I., & Pérez-Álvarez, M. (2017). Emotional state and psychological flexibility in breast cancer survivors. European Journal of Oncology Nursing, 30, 75-83. https://doi.org/10.1016/j.ejon.2017.08.006
  • Hayes, A. F. (2017). Partial, conditional, and moderated mediation: Quantification, inference, and interpretation. Communication Monographs, 85(1), 4-40. https://doi.org/10.1080/03637751.2017.1352100
  • Hayes, S. C., Barnes-Holmes, D., & Wilson, K. G. (2012). Contextual behavioral science: Creating a science more adequate to the challenge of the human condition. Journal of Contextual Behavioral Science, 1(1), 1-16. https://doi.org/10.1016/j.jcbs.2012.09.004
  • Hayes, S. C., Hofmann, S. G., Stanton, C. E., Carpenter, J. K., Sanford, B. T., Curtiss, J. E., & Ciarrochi, J. (2019). The role of the individual in the coming era of process-based therapy. Behaviour Research and Therapy, 117, 40-53. https://doi.org/10.1016/j.brat.2018.10.005
  • Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press.
  • Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152-1168. https://doi.org/10.1037/0022-006X.64.6.1152
  • Hekmati, I., Ranjbar, H. A., Eskin, M., Drake, C. E., & Jobson, L. (2021). The moderating role of experiential avoidance on the relationship between cognitive fusion and psychological distress among Iranian students. Current Psychology, 1-8. https://doi.org/10.1007/s12144-021-01539-4
  • Hopko, D. R., Lejuez, C. W., Ruggiero, K. J., & Eifert, G. H. (2003). Contemporary behavioral activation treatments for depression: Procedures, principles, and progress. Clinical Psychology Review, 23(5), 699-717. https://doi.org/10.1016/s0272-7358(03)00070-9
  • Janssen, N. P., Hendriks, G. J., Baranelli, C. T., Lucassen, P., Voshaar, R. O., Spijker, J., & Huibers, M. J. (2021). How does behavioural activation work? A systematic review of the evidence on potential mediators. Psychotherapy and Psychosomatics, 90(2), 85-93. https:// doi.org/10.1159/000509820
  • Lejuez, C. W., Hopko, D. R., & Hopko, S. D. (2001). A brief behavioral activation treatment for depression: Treatment manual. Behavior Modification, 25(2), 255-286. https://doi. org/10.1177/0145445501252005
  • Lewinsohn, P. M. (1974). A behavioral approach to depression. In J. C. Coyne (Ed.), Essential papers on depression (pp. 150-172). New York University Press.
  • López de Uralde Selva, M. D., & Valero Aguayo, L. (2021). Cognitive defusion as a verbal exercise: An experimental approach. Psicothema, 33(1), 77-85. https://doi.org/10.7334/psicothema2020.103
  • Manos, R. C., Kanter, J. W., & Busch, A. M. (2010). A critical review of assessment strategies to measure the behavioral activation model of depression. Clinical Psychology Review, 30(5), 547-561. https://doi. org/10.1016/j.cpr.2010.03.008
  • Martell, C., Addis, M., & Dimidjian, S. (2004). Finding the action in behavioral activation: The search for empirically supported interventions and mechanisms of change. In S. C. Hayes, V. M. Follette & M. M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition (pp. 152-167). Guilford Press.
  • Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in context: Strategies for guided action. WW Norton & Co.
  • Meidlinger, P. C., & Hope, D. A. (2017). The new transdiagnostic cognitive behavioral treatments: Commentary for clinicians and clinical researchers. Journal of Anxiety Disorders, 46, 101-109. https://doi. org/10.1016/j.janxdis.2016.11.002
  • Norcross J. C., & Lambert, M. (2019). Psychotherapy Relationships that Work. Volume 1: Evidence-Based Therapist Contributions. Oxford University Press.
  • Ong, C. W., Pierce, B. G., Petersen, J. M., Barney, J. L., Fruge, J. E., Levin, M. E., & Twohig, M. P. (2020). A psychometric comparison of psychological inflexibility measures: Discriminant validity and item performance. Journal of Contextual Behavioral Science, 18, 34-47. https://doi.org/10.1016/j.jcbs.2020.08.007
  • Pérez-Álvarez, M. (2018). Psychology as a science of subject and comportment, beyond the mind and behavior. Integrative Psychological and Behavioral Science, 52(1), 5-51. https://doi.org/10.1007/s12124- 017-9408-4
  • Quintana, J. M., Padierna, A., Esteban, C., Arostegui, I., Bilbao, A., & Ruiz, I. (2003). Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 107(3), 216-221. https://doi.org/10.1034/ j.1600-0447.2003.00062.x
  • Rochefort, C., Baldwin, A. S., & Chmielewski, M. (2018). Experiential avoidance: An examination of the construct validity of the AAQ-II and MEAQ. Behavior Therapy, 49(3), 435-449. https://doi.org/10.1016/j. beth.2017.08.008
  • Romero-Moreno, R., Márquez-González, M., Losada, A., Gillanders, D., & Fernández-Fernández, V. (2014). Cognitive fusion in dementia caregiving: Psychometric properties of the Spanish version of the “Cognitive Fusion Questionnaire”. Behavioral Psychology/Psicología Conductual, 22(1), 117-132. https://doi.org/10.5093/clysa2018a8
  • Roush, J. F., Brown, S. L., Mitchell, S. M., & Cukrowicz, K. C. (2019). Experiential avoidance, cognitive fusion, and suicide ideation among psychiatric inpatients: The role of thwarted interpersonal needs. Psychotherapy Research, 29(4), 514-523. https://doi.org/10.1080/105 03307.2017.1395923
  • Ruiz, F. J., Langer, A. I., Luciano, C., Cangas, A. J., & Beltrán, I. (2013). Measuring experiential avoidance and psychological inflexibility: The Spanish version of the Acceptance and Action Questionnaire II. Psicothema, 25(1), 123-129. https://doi.org/10.7334/ psicothema2011.239
  • Russell, L. H., Bardeen, J. R., Clayson, K. A., Dolan, S. L., & Fergus, T. A. (2020). The closed response style and posttraumatic stress: Examining the interaction between experiential avoidance and cognitive fusion among women experiencing sexual trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 12(6), 627-634. https://doi. org/10.1037/tra0000580
  • Santos, M. M., Puspitasari, A. J., Nagy, G. A., & Kanter, J. W. (2021). Behavioral activation. In A. Wenzel (Ed.), Handbook of cognitive behavioral therapy: Overview and approaches (pp. 235-273). American Psychological Association. https://doi.org/10.1037/0000218-009
  • Santos, M. M., Rae, J. R., Nagy, G. A., Manbeck, K. E., Hurtado, G. D., West, P., Santiago-Ribera, A., & Kanter, J. W. (2017). A client-level session-by-session evaluation of behavioral activation’s mechanism of action. Journal of Behavior Therapy and Experimental Psychiatry, 54, 93-100. https://doi.org/10.1016/j.jbtep.2016.07.003
  • Sanz, J., & García-Vera, M. P. (2007). Análisis psicométrico de las versiones breves del Inventario para la Depresión de Beck de 1978 (BDI-IA) [A psychometric analysis of the short forms of the 1978 version of the Beck Depression Inventory (BDI-IA)]. Psicología Conductual, 15(4), 191-214.
  • Spinhoven, P., Batelaan, N., Rhebergen, D., van Balkom, A., Schoevers, R., & Penninx, B. W. (2016). Prediction of 6-yr symptom course trajectories of anxiety disorders by diagnostic, clinical and psychological variables. Journal of Anxiety Disorders, 44, 92-101. https://doi.org/10.1016/j. janxdis.2016.10.011
  • Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. https:// doi.org/10.1001/archinte.166.10.1092
  • Xiong, A., Lai, X., Wu, S., Yuan, X., Tang, J., Chen, J., & Hu, M. (2021). Relationship between cognitive fusion, experiential avoidance, and obsessive-compulsive symptoms in patients with obsessive-compulsive disorder. Frontiers in Psychology, 12, Article 655154. https://doi. org/10.3389/fpsyg.2021.655154
  • Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361-370. https://doi. org/10.1111/j.1600-0447.1983.tb09716.x
Fuente de los datos: Dialnet